NHS chiefs order hospitals to begin urgent overhaul of A&E care

NHS chiefs have ordered hospitals to push through an urgent overhaul of A&E care, with GPs assessing every patient when they turn up to help the health service avoid another winter crisis.

The move comes as the NHS in England disclosed that it recorded its worst performance to date in January, missing vital treatment targets covering A&E, cancer and planned hospital care. The number of patients stuck in hospitals due to inadequate social care, such as a shortage of care home places, also hit an all-time high.

In a speech on Thursday, Jeremy Hunt, the health secretary, added to the pressure on hospitals by telling them to get back to meeting the target of treating 95% of A&E patients within four hours. That fell to 77.6% in January as hospitals buckled under unprecedented demand for emergency care.

However, hospital chiefs immediately criticised Hunt’s edict as “unrealistic” and demanded much more money to improve A&E care than the £100m in Wednesday’s budget.

NHS groups have voiced serious doubts as to whether there are enough GPs in England to work at every A&E unit. Dr Helen Stokes-Lampard, the chair of the Royal College of GPs, said: “We feel that the best place for GPs is working with patients in their communities and the money just announced for new triage systems in emergency departments would achieve more if most was spent shoring up general practice.”

The NHS England chief executive, Simon Stevens, and his counterpart at NHS Improvement, Jim Mackey, have written to all parts of the health service outlining “concrete changes” they must make to prevent next winter from overwhelming hospitals.

Over the previous winter, pictures of patients lying on trolleys in hospital corridors and countless stories about waiting many hours for ambulances caused major embarrassment to ministers and NHS chiefs.

Under the changes set out on Thursday:

• Ambulance crews will treat many more sick people where they find them, rather than bringing patients to hospital. In future, paramedics should be “conveying patients to hospital only when this is clinically necessary”, the letter says.
  


• Every hospital will have put in place “comprehensive front door streaming” by October, under which family doctors and nurses will assess how unwell patients are to reduce the risk of A&E units becoming overloaded by the 1.5 million to 3 million people who turn up unnecessarily every year.
  


• GP surgeries will have to offer many more appointments at weekends and in evenings, ultimately providing these to everyone in England by 2020.
  


• Doctors and nurses will have to provide better medical care to the 400,000 older people living in care homes, to stop them becoming so unwell that they need to be admitted to hospital.
  


• NHS bodies will work much more closely with local councils to reduce so-called bedblocking in hospitals. Councils will use the £1bn extra for social care in 2017-18 announced in Wednesday’s budget to provide more at-home care services and places in care homes.
  


• The NHS 111 telephone advice service will be overhauled to enable many more callers to speak to a doctor, nurse, mental health specialist or other type of health professional, as the Guardian reported on Wednesday.

Stevens and Mackey made it clear in their letter, published on Thursday, that NHS hospital trusts that do not implement every element of the plan will in effect be fined, by being denied money from the service’s £1.8bn-a-year sustainability and transformation hospital bailout fund.

Prof John Appleby, the chief economist at the Nuffield Trust health thinktank, said the latest performance figures “make dismal reading for the NHS and patients”.

“The number of patients stuck on a trolley waiting for a hospital bed has gone through the roof, with more than 80,000 patients waiting for four hours or more in January, and a staggering 988 of them waiting longer than 12 hours,” he said. “These are vulnerable people with acute medical needs. Corridors, it seems, have become the new emergency wards.”

Cancer charities criticised ministers over the NHS again missing the target for treating cancer patients referred for urgent treatment within 62 days.

Emma Greenwood, the director of policy at Cancer Research UK, said: “Today’s figures for January are the worst ever performance against this crucial cancer target, which has now been missed annually for three years. This is completely unacceptable.

“Cancer targets exist to ensure quick diagnosis and access to treatment, and provide a snapshot of how the NHS is performing for patients. The government and NHS England have committed to improving early diagnosis of cancer, including increasing investment, but it’s clear that this is yet to have an impact.

“Specifically, we have yet to see any significant progress to address huge staff shortages in the diagnostic workforce, especially for radiologists, pathologists, endoscopists and radiographers.”

NHS chiefs order hospitals to begin urgent overhaul of A&E care